Q&A | Martin Abrahamson, M.D., Chief Medical Officer

Thursday, February 11, 2010

Martin Abrahamson, M.D., runs the world’s leading diabetes clinic. Joslin’s Chief Medical Officer still makes time to see patients, and last fall he once again made Boston Magazine’s list of top doctors. Earlier this month Dr. Abrahamson took a few minutes to answer seven questions about his life in diabetes care.

Why did you become interested in endocrinology?

At medical school in South Africa, I found that endocrine physiology was fascinating. One can understand the clinical manifestations of endocrine diseases if you understand the physiology, and there’s a lot you can do for patients. There are some endocrine disorders that you can cure and there are others like diabetes, which are chronic and challenging, but there is so much one can do to help patients. Diabetes has many facets to it and requires a multi-disciplinary approach. While we cannot cure the disorder, there are so many tools that we have available today to help people with diabetes to live normal, healthier and longer lives.

How did you end up at Joslin?

I was recruited by what was then the Beth Israel Hospital to establish a clinical diabetes program. After Beth Israel and Deaconess merged, we had discussions with Joslin around a joint venture. With the signing of the joint venture, I became chief of adult diabetes at Joslin. Then, almost six years ago, I moved into my current position as medical director and now chief medical officer.

What’s most rewarding about your job?

First and foremost, I have the opportunity to work with so many terrific people who are dedicated to helping people with diabetes. Secondly, we can always continue to improve our care, to look at ways of innovating our care model, to measure what we do and to demonstrate that our care model is the best in the world. And thirdly, I’m still very dedicated to teaching and to clinical care. Trying to find a balance for all that is sometimes difficult!

What are the biggest challenges?

One is financial—the challenge of continuing to provide the highest quality care in an environment where reimbursement for “cognitive skills” like counseling patients is much less than for doing procedures. That challenge is getting harder. Another is trying to balance expectations for physicians to be clinically productive and have time to devote to academic work. And a third is finding ways to innovate our care model, and getting financial support to do so.

In diabetes management, what’s changing most quickly?

Over the last number of years, we’ve seen a lot of new drugs for controlling glucose, plus advances in other drugs to treat other risk factors for complications, like blood pressure and cholesterol. If you can help patients control their glucose, lipids and blood pressure, there’s an enormous reduction in the risk of complications. There also has been a significant improvement in the types of insulin we use to treat patients. What’s changing most quickly is the technology for pumps and insulin delivery devices, as well as sensors that can now continually monitor glucose readings.

What’s not changing is that all patients with diabetes still need to focus on lifestyle modifications as a core component of their treatment. And that continues to be a challenge.

What are some examples of progress in diabetes research that you find particularly striking?

I don’t do much research myself. In type 1 diabetes, I think the promise for the future lies in beta cell replacement, whether it’s stem cells or islets that can be harvested in such a way that they can be infused into patients without being destroyed by the patients’ immune system. There have been huge advances in that area of research. For patients with type 2 diabetes, we’ve seen enormous advances in understanding of insulin resistance and the pathogenesis of type 2 diabetes, so that new drugs can be developed to treat the disease.

If you have any spare time, what do you like to do with it?

I like to exercise—running, cycling or working out. It’s healthy, and if I’m preaching exercise to my patients, I’d better be doing it as well. I like to listen to music and play the piano, mostly by ear. I occasionally see movies and eat out. When I have time, I like to read biographies and fiction. And I’ve just become a convert to a Kindle—it’s an amazing thing to travel with!